National Vector Borne Disease Control Programme Includes control programme for Malaria, Filaria, Dengue, JE, Chikungunya and Kalazar

1. National Vector Borne
Disease Control Program
Dr Lipilekha Patnaik
Professor, Community Medicine
Institute of Medical Sciences & SUM Hospital
Siksha ‘O’Anusandhan deemed to be University
Odisha, India
Email: drlipilekha@yahoo.co.in

2. National Vector Borne Disease Control Programme
2
— Launched in 2003-04 by convergence of three
ongoing programmes on malaria, filaria & Kala Azar
and inclusion of Japanese Encephalitis and
Dengue/DHF.
— In 2007 Chikungunya fever added to this programme
due to re-emergence of the diseases in 2006.
— This program is now runs under the umbrella of
NHM.

3. Diseases included under
NVBDCP
3
•Malaria
•Filaria
•Kala-azar
•Japanese Encephalitis
•Dengue / Dengue
Hemorrhagic fevers
•Chikungunya

4. Organization Of The Program
4
— The Directorate of National Vector Borne
Diseases Control Programme is the national level
Technical Nodal office .
— Every state has state vector borne diseases control
component under the Directorate of Health
Services.
— At the district level, District Malaria Offices have
been established under District Chief Medical and
Health Offices by the states.

5. — Delivery of malaria control services by ASHAs and
other volunteers at the community and household
level in high endemic areas
— Enhancing supportive supervision and monitoring
by engaging DVBDC consultants at district level
and malaria technical supervisors(MTSs) at sub
district level.
5

6. Main activities of Directorate of NVBDCP
— Formulating policies & guidelines
— Providing technical guidance to the states
— Planning
— Logistics
— Monitoring & evaluation
— Coordination of activities through states/UTs
— Collaborationwith international organisations
— Training
— Facilitating research through NCDC, NIMR, RMRC etc
— Coordinating control activities in inter state & inter
country border areas
6

7. Strategies of NVBDCP
7

8. Miles stones in the field of Malaria Control
1.National malaria control Programme- 1953
2.National malaria eradication programme-1958
3.Urban malaria scheme -1971
4.Modified plan of operation (MPO) -1977
5.Malaria action Programme -1995
6.Enhanced malaria control project -1997
7.National Anti malaria Programme -1999
8. NVBDCP - 2002
9. Intensified malaria control project launched-2005
10.ACT -2008
11.World bank supported National malaria control project -2008
8

9. 12. Introduction of LLINs - 2009
13. New drug policy - 2010
14. Introduction of bivalent RDT - 2012
15. New drug policy 2013 - 2013
16. National framework for malaria elimination in
India - 2016
9

10. 10

11. Malaria Control Strategies
11
1. EPIDEMIOLOGICALsurveillance and case management
vCase detection active and passive.
vEarly diagnosis and completetreatment
vSentinel surveillance

12. 2. integrated vector management(IVM)
— ANTILARVALMEASURES
ØEnvironmental control
ØChemical control
ØBiological control
— ANTIADULT MEASURES
ØResidual sprays
ØSpace sprays
ØGenetic control
— PERSONAL PROTECTION
ØMosquito net
ØScreening
ØRepellants 12

13. 13
3.Epidemic preparedness and early response
4. STRENGTHENING OF REFERRALSERVICES
5. Supportive interventions
¡ Behavioral change communication(BCC)
¡ Public Private Partnership & intersectoral convergence
¡ Humanresourcedevelopmentthrough Capacity building
¡ Operational research including studies on drug resistance &
insecticide susceptibility
¡ Monitoring & evaluation through periodic reviews/ field
visits

14. — Early diagnosis and treatment of Malaria
aims at
1. Complete cure
2. Prevention of progression of uncomplicated malaria
to severe disease
3. Prevention of deaths
4. Interruptionof transmission
5. Minimizing risk of selection and spread of drug
resistant malaria parasite
14

15. NATIONAL FRAMEWORK FOR
MALARIA ELIMINATION IN INDIA
(2016-2030)
15

16. — VISION
Eliminate malaria nationally & contribute to improved
health, quality of life & alleviation of poverty
— GOALS
qEliminate malaria (zero indigenous cases) throughout
the entire country by 2030
qMaintain malaria free status in areas where malaria
transmission has been interruptedand prevent re-
introductionof malaria
16

17. Classification of states /UTs for malaria
elimination in India
— Category 0 (Prevention of re- establishment phase)
— Category 1 (Elimination phase)
— Category 2 (Pre- elimination phase)
— Category 3 (Intensified control phase)
17

18. 18
§ Urban Malaria Scheme (UMS )was launched in 1971 to over come
the increasing incidence of malaria in urban areas where the vector was
found to be An. Stephansi. Intensive anti larval measures and drug
treatment are the mainstay of UMS
§Reorganization - Malaria Units under NMEP were reorganized to
conform to the geographical boundaries of the district and the CDMO
was made responsible for implementation of the programme
§ Decentralization of Laboratory services-
Laboratory Technician with the necessary facilities is now located
at each PHC
§ Establishment of Drug Distribution Centers (DDCs) and
Fever Treatment Depots (FTDs)

19. Elimination of Lymphatic Filariasis
19
— Filariasis is endemic in 250 districts in 20 states and UTs.
— According to recent estimates about 600 million people
are exposed to the risk of infection.
— National filaria control program was started in 1955.
— In 1978, its operational component was merged with
Urban Malaria scheme and in 2003 -04 it was merged
with NVBDCP.
— Filariasis has been a major publichealth problem in
India next only to malaria.

20. 20
Revised Filaria Control Strategy
— The National Health Policy 2002 aimed at
Elimination of Lymphatic Filariasis by 2015
— REVISED STRATEGY
¡ Annual MDA with single doseof DEC and to be continued
for 5 years or more(exceptchildren below two years,
pregnant women and seriouslyill persons) in affected areas.
¡ Home based management of lymphoedemacases and up-
scaling of hydroceleoperations in identified CHCs/district
headquarter hospitals/medical colleges.

21. Elimination of Lymphatic Filariasis by 2015:
— LF ceases to be a public health problem i.e. the
number of microfilariacarriers is < 1 % in endemic
population.
— Children born after initiation of ELF are free from
circulating antigenaemia.
— Absence of antigenaemia among children is
considered as evidence for absence of transmission
and new infection.
21

22. 22
Progress and Achievement
•In pursuit of the goals, the Government of India launched
nationwide MDA in 2004 in endemic areas as well as home based
morbidity management, scaling up hydrocelectomies in hospitals
and CHCs.
•During the year 2004, only 202 districts could be covered with
coverage rate of 72.6%.
•The number of districts was upscaled and in 2007 all the 250
known LF endemic districts were brought under MDA.
•The population coverage during MDA has improved from 73% in
2004 to 83% in 2013 which has resulted in the overall reduction of
microfilaria rate from 1.24% in 2004 to 0.29% in 2013.

23. 23
Validation through TransmissionAssessment Survey (TAS)
•All the districts have completed more than 5 rounds of MDA by the end
of 2014, and are required to be evaluated to decide whether to stop or
continue MDA.
•As per WHO guidelines-2011, the districts having observed minimum
five rounds of MDA with more than 65% coverage against total
population at risk are to be subjected for Transmission Assessment
Survey (TAS) using Immuno-chromatographic test (ICT) for presence of
circulating antigenaemia in children born after initiation of MDA to know
the current infection.
•During July 2012, WHO conducted a Regional Workshop on Capacity
Building on TAS at Puducherry (India) for all Member countries of
SEAR.
• Till May 2015, 49 districts with 66 evaluation units (approx. 2 million
population each) have been successfully cleared through TAS and
qualified for MDA stoppage.
•During 2015-16, TAS was expected to be carried out in 68 districts.

24. 24
Morbidity Management and Disability Alleviation
•Morbidity Management is another pillar of strategy for ELF and
states/UTs were advised on up-scaling home based morbidity management
of Lymphoedemacases and Hydrocele operations.
•The process involved updating the line-listing of Lymphoedema &
Hydrocele cases in the districts.
•Demonstration and training on simple foot hygiene to affected persons
and motivatethem for self practice.
•Motivate for surgical intervention to hydrocele cases.
•The updated report from LF endemic states/UTs indicated 8.27 lakh
Lymphoedema and 3.76 lakh hydrocele cases.
•Since 2004, the states/UTs have reported 129572 hydrocele operations.
Different states have initiated management of Lymphodema cases through
demonstrating home based foot hygiene method to patients at local levels.

25. 25
Dengue/DHF
— There was a major out break
of Dengue /DHF in Delhi in
1996.
— Since then many focal
outbreaks have been reported
from different areas of the
country mainly from urban
areas.
— This disease has been
included in NVBDCP in
2003 -04
Aedes aegypti

26. — Caused by type B flavivirus- serotypes: 1,2,3,4
— Transmitted through Ades aegypti
— Reservoir of infection – man & mosquito
Infection may be – asymptomatic
-classical dengu fever
-dengu haemorrhagic fever without shock
-dengu haemorrhagic fever with shock
26

27. 27
Control Strategy
— Public awareness and community involvementis the key issue
in the strategy to control Dengue/DHF
— All efforts should be made against the breeding of Aedes egypti
mosquitoes
by sourcereduction
— Protection from mosquito
bites
— Early diagnosis and prompt
treatmentof cases

28. 28
Government of India has taken various steps for prevention and control of
Dengue and Chikungunya in the country as detailed below:
1. Developed a Long term action plan for Prevention and Control of
Dengue in the country and sent to the State(s) on January 2007 for
implementation.
2. National guidelines for clinical management of Dengue Fever, Dengue
Haemorrhagic Fever, Dengue Shock Syndrome has been sent to the
State(s) April 2007 for circulation in all hospitals.
3. Established Sentinel Surveillance Hospitals with laboratory support for
augmentation of diagnostic facility for Dengue in endemic State(s) in
2007 which has been increased to170 in 2009. All these are linked with
13 Apex Referral Laboratories with advanced diagnostic facilities for
back up support.
4. To maintain the uniformity and standard of diagnostics in these
laboratories IgM MAC ELISA test kits are provided through National
Institute of Virology (NIV), Pune. Cost is borne by GOI.
5. Diagnosis of Dengue and Chikungunya is provided to the community at
free of cost.

29. Japanese Encephalitis
— Zoonotic disease caused by Gr. B arbovirus.
— It is transmitted by bites of female mosquitoes mainly Culex
tritaeniorhynchus, Culex vishnui and Culex
pseudovishnui group.
— JE virus is primarily zoonotic in its natural cycle and man is
an accidental host.
— The virus is neurotorpic and primarilyaffects central
nervous system.
29

30. Control Strategy
— Care of the patient to prevent sequel
— Development of a safe & standard vaccine
— Sentinel surveillance including clinical
surveillance of suspected cases.
— Studies to identify high risk cases
— Epidemiological monitoring of the disease and
effective implementation of preventive and control
measures
30

31. ACTION TAKEN BY GOVT. OF INDIA TOWARDS
PREVENTION & CONTROL OF AES/JE
— JE vaccination campaign was launched during 2006
— Re-orientation training course on AES/JE case
management is a continuing process.
— The diagnostic facilities have been strengthened at 50
sentinel and 13 Apex Referral Laboratories. These have
been supplied with diagnostic kits free of cost from
National Institute of Virology (NIV), Pune.
— Guidelines were developed on AES/JE case management
and on prevention and control of Entero-viruses which
have been circulated to the states.
31

32. KALA-AZAR
— Caused by L. Donovani.
— Transmitted to man by biteof female sandfly.
— In India, endemic states- Bihar, Jharkhand, W.B, U.P
— Target is to reduce annual incidence of kala-azar to
< 1/10,000 population at block PHC level
32

33. Strategy
33
— Enhanced case detection and Complete treatment
including introduction of rK39 rapid diagnostic kits
and oral drug Miltefosine for t/t.
— Interruption of transmission through Vector control by
insecticidal residual spray (IRS ) with synthetic
pyrethroid up to 6 feet height from the ground twice
annually.
— BCC & intersectoral convergence.
— Capacity Building
— Monitoring, supervision & evaluation

34. ACTIVE CASE SEARCH :
— The frequency of case searches has been increased from a
single annual case search to quarterly case searches. The
active case searches are carried out during a fortnight
designated as the “Kala-azar Fortnight”, during which the
peripheral health workers and volunteers make door-to-
door search and refer the cases to the treatment centres for
definitive diagnosis and treatment.
— An incentive amountof Rs. 300 is provided to ASHA for
identifying each case of kala-azar and Rs. 100 for ensuring
one round and Rs 200 for two rounds during insecticide
spraying.
— Even the patient being treated in the hospital will be given
Rs. 500 as compensationof daily wage for the time he
spends in the hospital during the treatment.
34

35. — This revised strategy of total eradication of kala-azar
was launched on 2nd September 2014.
— The new strategy also includes introductionof Rapid
Diagnostic Kit developed by ICMR into the
programme and single dose treatment with Liposomal
Amphoterecin B, which is given intravenously in 10 mg
dose.
— It is to reduce the human reservoir of infection.
35

36. CHIKUNGUNYA FEVER
— Chikungunya fever is a debilitating non-fatal viral
illness, re-emerging in the country after a gap of three
decades.
— Govt, of India is continuously monitoring the
situation.
— Guidelines for prevention and control of the disease
have been prepared.
36

37. — Since same vector is involved in the transmission of
dengue and chikungunya, strategies for transmission
risk reduction by vector control are also the same.
— For carrying out proactivesurveillance and enhancing
diagnostic facilities for chikungunya, the sentinel
surveillance hospitals involved in dengue in the
affected states also carry out chikungunya tests.
— The diagnostic kits are providedthrough National
Instituteof Virology, Pune, by the central government.
37

38. THANK YOU
38